PLEASE PRINT NEATLY AND IN CAPITAL LETTERS. 1- LAST NAME ... an
observer is on board), or, for non-vessel fisheries, within 48 hours of an
occurrence of an incidental mortality or injury. A separate ... O648-0292 (expires
02/29/2016) ...
MARINE MAMMAL AUTHORIZATION PROGRAM MORTALITY/INJURY REPORTING FORM National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910
PLEASE PRINT NEATLY AND IN CAPITAL LETTERS 1- LAST NAME OF VESSEL OWNER/OPERATOR
2- FIRST NAME OF VESSEL OWNER/OPERATOR
3-MI
4-MAILING ADDRESS
5- CITY
6- STATE
7- ZIP
8- VESSEL NAME
9- COAST GUARD DOC. NO. OR VESSEL STATE REG. NO.
11- FISHERY I.D. NO.
10- STATE COMMERCIAL VESSEL NO.
12- FISHERY GEAR TYPE AND TARGET SPECIES
13- DATE OF MORTALITY/INJURY (MM DD YYYY)
14- APPROXIMATE TIME OF MORTALITY/INJURY . AM/PM .
15- LOCATION OF MORTALITY/INJURY LATITUDE
o
‘
LONGITUDE
o
‘
16- TYPE OF INTERACTION (PLACE AN “X”) INCIDENTAL INTENTIONAL 17- ENTER SPECIES CODE, TYPE OF MORTALITY/INJURY (SEE LIST OF CODES ON PREVIOUS PAGE), AND THE NUMBER OF EACH SPECIES INVOLVED. MAKE ONE ENTRY FOR EACH SPECIES INVOLVED IN THIS INCIDENT. YOU MAY MAKE UP TO THREE MORTALITY/INJURY CODES PER SPECIES. SPECIES
MORTALITY/INJURY CODE
NUMBER
18- DESCRIPTION OF UNKNOWN SPECIES OR CIRCUMSTANCES OF MORTALITY/INJURY INCIDENT
OMB CONTROL NO. 0648-0292 (expires 02/29/2016)
NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES
NOAAINMFS OFFICE OF PROTECTED RESOURCES F/PR2 1315 EAST WEST HIGHWAY SILVER SPRING MD 20910-9721
BUSINESS REPLYSILVER MAIL SPRING, MD PERMIT NO. 7411
FIRST-CLASS MAIL
POSTAGE WILL BE PAID BY ADDRESSEE
NATIONAL OCEANIC & ATMOSPHERIC ADMINISTRATION NATIONAL MARINE FISHERIES SERVICE OFFICE OF PROTECTED RESOURCES F jPR2 1315 EAST WEST HIGHWAY SILVER SPRING MD 20910-9721
1•• 1.111 ••• 1.1 ••••• 1111 ••• 1.1 •• 1••• 1•• 1.1 ••• 111.1 •• 1
IMPORTANT! MARINE MAMMAL REPORTING FORM
MARINE MAMMAL AUTHORIZATION PROGRAM MORTALITY/INJURY REPORTING FORM National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910
INSTRUCTIONS FOR COMPLETING THE MORTALITY/INJURY REPORTING FORM This reporting form is required ONLY WHEN there is an incidental mortality or injury to a marine mammal during commercial fishing activities. You are required to report the incidental mortality or injury within 48 hours after the end of the fishing trip (even if an observer is on board), or, for non-vessel fisheries, within 48 hours of an occurrence of an incidental mortality or injury. A separate report form is required for each fishery, for each date, and for each location. PLEASE PRINT NEATLY AND IN CAPITAL LETTERS. The reporting form should be detached from this instruction sheet, folded, and sealed prior to mailing. No postage is necessary for mailing. Forms may also be faxed to NMFS at (301) 713-4060. Questions regarding completion of this form, and requests for additional forms, may be directed to the NMFS Office of Protected Resources, 1315 East-West Hwy., Silver Spring, MD 20910-3226, (301) 713-2322.
MORTALITY/INJURY REPORT FIELD DEFINITIONS 123456789-
10 11 -
12 13 14 15 16 17 -
18 -
LAST NAME: Enter the last name of the vessel owner/operator or permit holder. FIRST NAME: Enter the first name of the vessel owner/operator or permit holder. MI: Enter the middle initial of the owner/operator of the vessel or permit holder. ADDRESS: Enter the street address or P.O. Box number of the vessel owner/operator or permit holder. CITY: Enter the city name of the vessel owner/operator or permit holder. STATE: Enter the 2-digit state code of the vessel owner/operator or permit holder. ZIP: Enter the zip code of the vessel owner/operator or permit holder. VESSEL NAME: Enter the name of the vessel as it is identified for commercial fishing operations. For non-vessel fisheries, leave this blank. COAST GUARD DOCUMENT NO.: Enter the vessel’s Coast Guard Documentation number; OR Enter the VESSEL’S STATE REGISTRATION NO.: One of these numbers must be provided. For non-vessel fisheries, enter the state fishery permit number. STATE COMMERCIAL VESSEL LICENSE NO.: Enter the vessel’s state commercial vessel license number, if applicable. FISHERY IDENTIFICATION NO.: (Category I or Category II fisheries) Enter the NMFS’ fishery I.D. number (indicated on the vessel’s MMAP authorization certificate) for the fishery in which this incident occurred. If the fishery ID number is unknown, or the vessel is not registered under the MMAP, fill in gear type and target species under item 12. GEAR TYPE AND TARGET SPECIES: (Category III fisheries) Enter the type of fishing gear used and the target species being fished when this incident occurred. DATE OF MORTALITY/INJURY: Enter the date the mortality/injury occurred. For example: November 1, 2009 is entered as 11/01/2009. TIME OF MORTALITY/INJURY: Enter the approximate time of day the mortality/injury occurred. Indicate AM if the mortality/injury occurred between midnight & noon, or PM if the mortality/injury occurred between noon and midnight. LOCATION OF MORTALITY/INJURY LATITUDE & LONGITUDE: Use standard entries in degrees and minutes. TYPE OF INTERACTION: Enter whether this incident was incidental or intentional. SPECIES INCIDENTALLY KILLED OR INJURED: Enter the species code and the mortality/injury code of the animal(s) involved. (Refer to the species and mortality/injury code lists included on page 2 of these instructions.) Enter the number of animals involved in each mortality/injury. You may enter up to three (3) injury codes per species. Make as many entries as apply to the date, time, and location entered in items 13-15. DESCRIPTION OF UNKNOWN SPECIES: If you have entered a species code for an unidentified species, please provide a detailed description of the animal involved, including color patterns, length, and body shape (drawings are helpful). State whether the animal involved was a cetacean (whale, dolphin, or porpoise), pinniped (seal or sea lion), walrus, manatee or sea otter. You may also use this space for other comments regarding this incident.
OMB Control No. O648-0292 (expires 02/29/2016)
MARINE MAMMAL AUTHORIZATION PROGRAM MORTALITY/INJURY REPORTING FORM National Marine Fisheries Service, 1315 East-West Highway, Silver Spring, MD 20910
SPECIES AND STOCK CODES FOR MARINE MAMMALS Pinnipeds (seals and sea lions)
Small Cetaceans (dolphins and porpoises)
Large Cetaceans (toothed whales and baleen whales)
100101105115116117121124127129130131132203204205-
047049053054055058060061063068072235-
002005007010011012016038039221230231232210220-
Steller (northern) sea lion California sea lion Northern (Pribilof) fur seal Harbor seal Spotted seal Ringed seal Ribbon seal Gray seal Hawaiian monk seal Northern elephant seal Bearded seal Harp seal Hooded seal Unidentified sea lion Unidentified seal Unidentified pinniped
Atlantic white-sided dolphin Pacific white-sided dolphin Common dolphin Bottlenose dolphin Grampus (Risso’s) dolphin Spotted dolphin Spinner dolphin Striped dolphin Northern right whale dolphin Harbor porpoise Dall’s porpoise Unidentified small cetacean (porpoise or dolphin)
North Atlantic right whale Gray whale Fin whale Minke whale Humpback whale Sperm whale Beluga whale False killer whale Killer whale Pilot whale Beaked whale Bryde’s whale Dwarf sperm whale Unidentified baleen whale Unidentified toothed whale
Other Marine Mammals 114- Walrus
135- Sea otter
139- Manatee
MORTALITY/INJURY CODES FOR MARINE MAMMALS 01 020304050607-
Visible blood flow Loss of/damage to appendage/jaw Inability to use appendage(s) Asymmetry in shape of body or body position Any noticeable swelling or hemorrhage (bruising) Laceration (deep cut) Rupture or puncture of eyeball
08091011121314-
Listlessness or inability to defend Inability to swim or dive Equilibrium imbalance Ingestion of gear Released trailing gear/gear perforating body Other wound or injury Killed
COLLECTION MANDATE This collection of information is mandated by the Marine Mammal Protection Act of 1972, as amended (16 U.S.C. 1361 et. seq.), and by implementing regulations contained at 50 CFR 229.4. The information supplied on this form will be used by the National Marine Fisheries Service to estimate levels of incidental mortalities and injuries in U.S. commercial fisheries. Certain information supplied on this form may be considered proprietary and therefore subject to data confidentiality restrictions of 50 CFR Part 229.11. Public reporting burden for this collection of information is estimated to average 0.15 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Director, Office of Protected Resources, National Marine Fisheries Service, 1315 East-West Hwy., Silver Spring, MD 20910-3226. The National Marine Fisheries Service may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current and valid OMB control number. The OMB control number for this form is 0648-0292, which expires on 11/30/2012.
OMB Control No. O648-0292 (expires 02/29/2016)
